001.
<?php
002.
include
'config.php'
;
003.
?>
004.
005.
<!doctype html>
006.
<html lang=
"en"
>
007.
008.
<head>
009.
<meta charset=
"utf-8"
/>
010.
<meta http-equiv=
"X-UA-Compatible"
content=
"IE=edge,chrome=1"
/>
011.
<title>
012.
เพิ่มข้อมูล
013.
</title>
014.
<meta content=
'width=device-width, initial-scale=1.0, maximum-scale=1.0, user-scalable=0, shrink-to-fit=no'
name=
'viewport'
/>
015.
<!-- Fonts
and
icons -->
018.
<!-- CSS Files -->
019.
020.
<!-- นำเข้า CSS จาก Bootstrap -->
022.
023.
<!-- นำเข้า CSS จาก me -->
024.
<link rel=
"stylesheet"
href=
"me2.css"
>
025.
<!-- นำเข้า Javascript จาก Jquery -->
026.
<script type=
"text/javascript"
src=
"jquery-3.5.1.js"
></script>
027.
<script src=
"repeater.js"
type=
"text/javascript"
></script>
028.
029.
</head>
030.
031.
<body
class
=
""
>
032.
<?php
033.
$sql3
=
"select * from provinces"
;
034.
$query3
= mysqli_query(
$conn
,
$sql3
);
035.
?>
036.
<br>
037.
038.
<div
class
=
"container"
>
039.
</br>
040.
041.
<form method=
"post"
id=
"repeater_form"
enctype=
"multipart/form-data"
>
042.
<div
class
=
"form-group"
>
043.
<label
for
=
"validationDefault01"
>ลำดับ </label>
044.
<input type=
"text"
class
=
"form-control"
id=
"send_id"
name=
"send_id"
placeholder=
""
value=
""
>
045.
</div>
046.
<div id=
"repeater"
>
047.
<div
class
=
"repeater-heading"
align=
"right"
>
048.
<button type=
"button"
class
=
"btn btn-primary repeater-add-btn"
>เพิ่มข้อมูล</button>
049.
</div></br>
050.
<div
class
=
"clearfix"
></div>
051.
<div
class
=
"items"
data-group=
"programming_languages"
>
052.
<div
class
=
"item-content"
>
053.
<div
class
=
"card"
>
054.
<div
class
=
"card-header text-white "
style=
"background : #64C5DB;"
>
055.
เพิ่มข้อมูล
056.
</div>
057.
<div
class
=
"card-body"
>
058.
<div
class
=
"form-group"
>
059.
<div
class
=
"form-row"
>
060.
<div
class
=
"col-md-12 mb-12"
>
061.
<label
for
=
"validationDefault01"
>ชนิดตัวอย่าง </label></br>
062.
<div
class
=
"form-check form-check-inline"
>
063.
<input
class
=
"form-check-input"
type=
"checkbox"
id=
"inlineCheckbox1"
value=
"Urine"
data-skip-name=
"true"
data-name=
"sample_type[]"
>
064.
<label
class
=
"form-check-label"
for
=
"inlineCheckbox1"
>Urine</label>
065.
</div>
066.
<div
class
=
"form-check form-check-inline"
>
067.
<input
class
=
"form-check-input"
type=
"checkbox"
id=
"inlineCheckbox2"
value=
"Stool"
data-skip-name=
"true"
data-name=
"sample_type[]"
>
068.
<label
class
=
"form-check-label"
for
=
"inlineCheckbox2"
>Stool</label>
069.
</div>
070.
<div
class
=
"form-check form-check-inline"
>
071.
<input
class
=
"form-check-input"
type=
"checkbox"
id=
"inlineCheckbox3"
value=
"Serum"
data-skip-name=
"true"
data-name=
"sample_type[]"
>
072.
<label
class
=
"form-check-label"
for
=
"inlineCheckbox3"
>Serum</label>
073.
</div>
074.
<div
class
=
"form-check form-check-inline"
>
075.
<input
class
=
"form-check-input"
type=
"checkbox"
id=
"inlineCheckbox1"
value=
"Plasma"
data-skip-name=
"true"
data-name=
"sample_type[]"
>
076.
<label
class
=
"form-check-label"
for
=
"inlineCheckbox1"
>Plasma</label>
077.
</div>
078.
<div
class
=
"form-check form-check-inline"
>
079.
<input
class
=
"form-check-input"
type=
"checkbox"
id=
"inlineCheckbox2"
value=
"Sputum"
data-skip-name=
"true"
data-name=
"sample_type[]"
>
080.
<label
class
=
"form-check-label"
for
=
"inlineCheckbox2"
>Sputum</label>
081.
</div>
082.
<div
class
=
"form-check form-check-inline"
>
083.
<input
class
=
"form-check-input"
type=
"checkbox"
id=
"inlineCheckbox3"
value=
"Thoat swab"
data-skip-name=
"true"
data-name=
"sample_type[]"
>
084.
<label
class
=
"form-check-label"
for
=
"inlineCheckbox3"
>Thoat swab</label>
085.
</div>
086.
<div
class
=
"form-check form-check-inline"
>
087.
<input
class
=
"form-check-input"
type=
"checkbox"
id=
"inlineCheckbox1"
value=
"Nasophyngel swab"
data-skip-name=
"true"
data-name=
"sample_type[]"
>
088.
<label
class
=
"form-check-label"
for
=
"inlineCheckbox1"
>Nasophyngel swab</label>
089.
</div>
090.
<!-- ลบ checkbox บางส่วน เพื่อไม่ให้โค้ด ยาว เกินไปนะคะ-->
091.
092.
</div>
093.
<div
class
=
"col-md-6 mb-3"
>
094.
<label
for
=
"validationDefault02"
>ชื่อ - นามสกุล ผู้ป่วย</label>
095.
<input type=
"text"
class
=
"form-control"
id=
""
data-skip-name=
"true"
data-name=
"fullname[]"
value=
""
>
096.
</div>
097.
<div
class
=
"col-md-3 mb-3"
>
098.
<label
for
=
"validationDefault02"
>เพศ</label><br>
099.
<div
class
=
"form-check-inline"
>
100.
<input
class
=
"form-check-input"
type=
"radio"
data-name=
"sex[]"
id=
"exampleRadios1"
value=
"M"
checked>
101.
<label
class
=
"form-check-label"
for
=
"exampleRadios1"
>
102.
ชาย
103.
</label>
104.
</div>
105.
<div
class
=
"form-check-inline"
>
106.
<input
class
=
"form-check-input"
type=
"radio"
data-name=
"sex[]"
id=
"exampleRadios2"
value=
"F"
>
107.
<label
class
=
"form-check-label"
for
=
"exampleRadios2"
>
108.
หญิง
109.
</label>
110.
</div>
111.
112.
</div>
113.
<div
class
=
"col-md-3 mb-3"
>
114.
<label
for
=
"validationDefault01"
>อายุ </label>
115.
<input type=
"text"
class
=
"form-control"
id=
""
data-skip-name=
"true"
data-name=
"age[]"
placeholder=
""
value=
""
>
116.
</div>
117.
</div>
118.
119.
<div
class
=
"form-row"
>
120.
121.
<div
class
=
"col-md-4 mb-3"
>
122.
<label
for
=
"validationDefault02"
>ป่วยที่บ้านเลขที่</label>
123.
<input type=
"text"
class
=
"form-control"
id=
""
data-skip-name=
"true"
data-name=
"address[]"
placeholder=
""
value=
""
>
124.
</div>
125.
<div
class
=
"col-md-3 mb-3"
>
126.
<label
for
=
"validationDefault02"
>จังหวัด</label>
127.
<select data-skip-name=
"true"
data-name=
"province[]"
id=
"provinces"
class
=
"form-control"
>
128.
<option value=
""
selected disabled>กรุณาเลือกจังหวัด</option>
129.
<?php
foreach
(
$query3
as
$value
) { ?>
130.
<option value=
"<?= $value['id'] ?>"
><?=
$value
[
'name_th'
] ?></option>
131.
<?php } ?>
132.
133.
</select>
134.
</div>
135.
<div
class
=
"col-md-3 mb-3"
>
136.
<label
for
=
"amphure"
>อำเภอ</label>
137.
<select data-skip-name=
"true"
data-name=
"district[]"
id=
"amphures"
class
=
"form-control"
>
138.
<option value=
""
>เลือกอำเภอ</option>
139.
</select>
140.
</div>
141.
<div
class
=
"col-md-2 mb-3"
>
142.
<label
for
=
"district"
>ตำบล</label>
143.
<select data-skip-name=
"true"
data-name=
"sub_district[]"
id=
"districts"
class
=
"form-control"
>
144.
<option value=
""
>เลือกตำบล</option>
145.
</select>
146.
</div>
147.
</div>
148.
149.
<div
class
=
"col-md-12"
style=
"margin-top:24px;"
align=
"right"
>
150.
<button id=
"remove-btn"
onclick=
"$(this).parents('.items').remove()"
class
=
"btn btn-danger"
>ลบ</button>
151.
</div>
152.
</div>
153.
</div>
154.
</div>
155.
</div></br></br>
156.
</div>
157.
</div>
158.
<div
class
=
"clearfix"
></div>
159.
<div
class
=
"form-group"
align=
"center"
>
160.
<br /><br />
161.
<input type=
"submit"
name=
"insert"
class
=
"btn btn-success"
value=
"ตกลง"
/>
162.
<input name=
"Back"
type=
"button"
class
=
"btn btn-danger"
value=
" ยกเลิก"
onClick=
"jascript:history.go(-1)"
></br></br>
163.
<div
class
=
"row"
>
164.
<span align=
"center"
id=
"success_result"
></span>
165.
</div>
166.
</div>
167.
</form>
168.
</div>
169.
<br>
170.
<script>
171.
$(document).ready(
function
() {
172.
173.
$(
'#repeater'
).createRepeater();
174.
175.
$(
'#repeater_form'
).on(
'submit'
,
function
(event) {
176.
event.preventDefault();
177.
var
formData =
new
FormData($(this)[0]);
178.
$.ajax({
179.
url:
"test_tb_insert1.php"
,
180.
type:
"POST"
,
181.
processData: false,
182.
contentType: false,
183.
data: formData,
184.
success:
function
(data) {
185.
$(
'#repeater_form'
)[0].reset();
186.
$(
'#repeater'
).createRepeater();
187.
$(
'#success_result'
).html(data);
188.
189.
?>';
190.
}
191.
})
192.
});
193.
});
194.
</script>
195.
<script type=
"text/javascript"
>
196.
function
sl_provinces(key) {
197.
var
id_province = $(
'#provinces_'
+ key).val();
198.
199.
$.ajax({
200.
type:
"post"
,
201.
url:
"ajax_address2_db.php"
,
202.
data: {
203.
id: id_province,
204.
function
:
'provinces'
205.
},
206.
success:
function
(data) {
207.
$(
'#amphures_'
+ key).html(data);
208.
$(
'#districts_'
+ key).html(
' '
);
209.
}
210.
});
211.
}
212.
213.
function
sl_amphures(key) {
214.
var
id_amphures = $(
'#amphures_'
+ key).val();
215.
216.
$.ajax({
217.
type:
"post"
,
218.
url:
"ajax_address2_db.php"
,
219.
data: {
220.
id: id_amphures,
221.
function
:
'amphures'
222.
},
223.
success:
function
(data) {
224.
225.
$(
'#districts_'
+ key).html(data);
226.
}
227.
});
228.
}
229.
230.
231.
232.
233.
234.
235.
236.
237.
238.
239.
240.
241.
242.
243.
244.
245.
246.
</script>
247.
250.
</body>
251.
252.
</html>
253.
254.
<?php
255.
mysqli_close(
$conn
);